Online Therapy in Turkey during the Covid-19 Pandemic: Examining the Experiences of Psychotherapists

Year 2025, Volume: 15 Issue: 76, 116 - 129, 31.03.2025

Emine Eker , Emel Genc

Abstract

The Covid-19 pandemic affected many people worldwide, causing limited in-person interactions and restricted mobility. For, mental health professionals, this entailed replacing face-to-face therapy sessions with online settings. Although many studies have claimed that such online mental health services are effective, it was a new method in Turkey. Thus, this study examines psychotherapists’ experiences while providing online therapy during the pandemic. Drawing on the phenomenological method, data were gathered through semi-structured interviews with 14 Turkish psychotherapists. Thematic analysis was employed to analyze the data. Three themes were identified: “technology,” “therapy process,” and “ethical issues.” The findings indicate that the therapists had difficulties preserving clients'’ confidentiality during online sessions and emphasized that a lack of training and supervision in online therapy contributed to ethical issues. Additionally, technical problems, including unstable internet connections, made it difficult to establish effective therapeutic relationships. The findings can help raise clinicians’ awareness of the potential risks of online therapy and suggest precautions for a better service. Psychotherapists in Turkey should also acquire internet-based intervention skills to enhance their confidence and online therapeutic competence.

Keywords

internet-based therapy, mental health professionals, online psychotherapy, pandemic, technology

Ethical Statement

The study was approved by Bartin University (2021-SBB-0343) on September 14, 2021

Supporting Institution

This study was funded by The Scientific and Technological Research Council of Türkiye.

References

• Aafjes-van Doorn, K., Békés, V., Prout, T. A., & Hoffman, L. (2020). Psychotherapists’ vicarious traumatization during the COVID-19 pandemic. Psychological Trauma: Theory Research Practice and Policy, 12(S1), S148–S150. https://doi.org/10.1037/tra0000868
• Bal, U., Yılmaz, E., Tamam, L. & Çakmak, S. (2015). Telepsikiyatri: Şimdi ve burada. Psikiyatride Güncel Yaklaşımlar, 7(2), 136-148. https://doi.org/10.5455/cap.20150320123914
• Braun, V., & Clarke, V. (2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589-597. https://doi.org/10.1080/2159676X.2019.1628806
• Bozkurt, İ. (2013). Psikolojik yardım uygulamalarında yeni trend: Online terapiler. International Journal of Human Sciences, 10(2), 130-147.
• Creswell, J.W. (2013). Qualitative inquiry and research design: Choosing among five approaches (3rd ed.). Thousand Oaks, CA: Sage.
• Çetintulum Huyut, B. (2019). Anksiyete bozukluklarının tedavisinde internet tabanlı bilişsel davranışçı terapi uygulamaları. Yaşam Becerileri Psikoloji Dergisi. 3(6), 251-263. https://doi.org/10.31461/ybpd.622846
• Emmungil, L. & Yılmaz, M. (2021). Çevrim içi canlı toplantılarda karşılaşılan sorunlar ve çözüm önerileri. Bilgi ve İletişim Teknolojileri Dergisi, 3(1), 109-123.
• Erdem, A. & Özdemi̇r, M. (2020). Çevrimiçi ve yüz yüze psikolojik danışmaya ilişkin algıları keşfetmek: Nitel bir çalışma. Psikiyatride Güncel Yaklaşımlar, 12, 331-363. https://doi.org/10.18863/pgy.793232
• Joshi, G., & Sharma, G. (2020). Burnout: a risk factor amongst mental health professionals during COVID-19. Asian Journal of Psychiatry, 54, 102300. https://doi.org/10.1016/j.ajp.2020.102300
• Knight Z. G. (2021). Living under lockdown in the shadow of the COVID-19 pandemic in South Africa: anxious voices from the unplanned shift to online therapy. Research in Psychotherapy, 23(3), 487. https://doi.org/10.4081/ripppo.2020.487
• Litam, S. D. A., Ausloos, C. D., & Harrichand, J. J. (2021). Stress and resilience among professional counselors during the COVID-19 pandemic. Journal of Counseling & Development, 99(4), 384– 395. https://doi.org/10.1002/jcad.12391
• Markowitz, J. C., Milrod, B., Heckman, T. G., Bergman, M., Amsalem, D., Zalman, H., … Neria, Y. (2021). Psychotherapy at a Distance. American Journal of Psychiatry, 178(3), 240–246. https://doi.org/10.1176/appi.ajp.2020.20050557
• Oktay, S., Merdan-Yıldız, E. D., Karaca-Dinç, P. & Erden G. (2021). Çevrimiçi psikoterapi yöntemlerinin farklı gruplar (yetişkin, çocuk, ergen ve aile) temelinde incelenmesi. Klinik Psikoloji Dergisi. https://doi.org/10.5455/kpd.26024438m000046
• Patton, M. Q. (2014). Qualitative research & evaluation methods: İntegrating theory and practice. SAGE Publications.
• Puspitasari, A. J., Heredia, D., Jr, Gentry, M., Sawchuk, C., Theobald, B., Moore, W., Tiede, M., G., C., & Schak, K. (2021). Rapid Adoption and Implementation of Telehealth Group Psychotherapy During COVID 19: Practical Strategies and Recommendations. Cognitive and Behavioral Practice, 28(4), 492–506. https://doi.org/10.1016/j.cbpra.2021.05.002
• Shklarski, L., Abrams, A., & Bakst, E. (2021). Will We Ever Again Conduct in-Person Psychotherapy Sessions? Factors Associated with the Decision to Provide in-Person Therapy in the Age of COVID-19. Journal of Contemporary Psychotherapy, 51(3), 265–272. https://doi.org/10.1007/s10879-021-09492-w
• Smith J.A., Flowers, P., & Larkin, M. (2009). Interpretive Phenomenological Analysis: Theory, Method and Research. (Sage, London)
• Stoll, J., Müller, J. A., & Trachsel, M. (2020). Ethical ıssues in online psychotherapy: a narrative review. Frontiers in Psychiatry, 10, 993. https://doi.org/10.3389/fpsyt.2019.00993
• Şen Pakyürek, G., & Korkmaz Yayın, B. (2023). Investigating Online Psychotherapy in the Framework of Ethical Codes. Studies in Psychology, 43(1), 1-39. https://doi.org/10.26650/SP2022-810217
• Tanhan, A., Yavuz, K. F., Young, J. S., Nalbant, A., Arslan, G., Yıldırım, M., Ulusoy, S., Genç, E., Uğur, E., & Çiçek, İ. (2020). A Proposed Framework Based on Literature Review of Online Contextual Mental Health Services to Enhance Wellbeing and Address Psychopathology During COVID-19. Electronic Journal of General Medicine, 17(6), em254. https://doi.org/10.29333/ejgm/8316
• TPD (2014). Türk Psikologlar Derneği Etik Yönetmeliği. url: https://www.psikolog.org.tr/tr/files/folder/etik-yonetmeligi-x389.pdf
• TPD (2020). Çevirimiçi Psikolojik Müdahale Ve Uygulamalar İçin Telepsikoloji Kılavuzu. url:https://www.psikolog.org.tr/tr/files/folder/telepsikoloji-kilavuzu-x150.pdf
• Tuna, B., & Avci, O. H. (2023). Qualitative analysis of university counselors' online counseling experiences during the COVID-19 pandemic. Current Psychology, 42(10), 8489–8503. https://doi.org/10.1007/s12144-023-04358-x
• Tuzgöl, K. (2020). Online psikoterapi ve danışmanlıkta Etik. Türkiye Bütüncül Psikoterapi Dergisi, 3(6), 67-86.
• Ulusoy, S. & Çelik, Z. (2020). Covid-19 sürecinde internet tabanlı müdahaleler bir seçenek olabilir mi? Bilişsel Davranışçı Psikoterapi ve Araştırmalar Dergisi, 9(2), 166-169. https://doi.org/10.5455/JCBPR.106343
• Wallin, E. E., Mattsson, S., & Olsson, E. M. (2016). The preference for ınternet-based psychological interventions by individuals without past or current use of mental health treatment delivered online: A survey study with mixed-methods Analysis. JMIR Mental Health, 3(2), e25. https://doi.org/10.2196/mental.5324
• Webster, P. (2020). Virtual health care in the era of COVID-19. Lancet. 395, 1180–1181. https://doi.org/10.1016/S0140-6736(20)30818-7
• Xiang, Y. T., Yang, Y., Li, W., Zhang, L., Zhang, Q., Cheung, T., & Ng, C. H. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet. Psychiatry, 7(3), 228–229. https://doi.org/10.1016/S2215-0366(20)30046-8
• Yazıcı, H., Altun, F., Tosun, C. & Özdemir, M. (2021). Covid-19 salgının ilk aylarında gözlenen psikolojik problemler ve ruh sağlığı uzmanlarının bu problemlere çevrimiçi (online) yollarla müdahale etmeye ilişkin deneyimleri. Atatürk Üniversitesi Sosyal Bilimler Enstitüsü Dergisi, 25(4), 1460-1484. https://doi.org/10.53487/ataunisosbil.900363
• Yıldırım, A. & Şimşek, H. (2005). Sosyal Bilimlerde Nitel Araştırma Yöntemleri (5. Baskı). Ankara: Seçkin Yayıncılık.
• Zeren, S. G., Erus, S. M., Amanvermez, Y., Genc, A. B., Yilmaz, M. B., & Duy, B. (2020). The effectiveness of online counseling for university students in Turkey: A non-randomized controlled trial. European Journal of Educational Research, 9(2), 825-834. https://doi.org/10.12973/eu-jer.9.2.825